Definition

The vital organs necessary for human life, such as the respiratory system, lungs, heart, and different blood vessels, are located inside the chest cavity. Damage to the chest region, whether from blunt force or stabbing, can result in major harm to these organs, which is commonly known as chest trauma.

Such trauma can affect the heart and lungs and harm other structures within the chest, such as the ribs, clavicles, trachea, esophagus, and major blood vessels. Moreover, chest trauma can manifest with symptoms of varying severity, ranging from mild to life-threatening.

Chest trauma can occur due to accidents, intentional stabbings, or blunt force. Other causes include falls from heights, violence, and accidents involving explosions. Because chest injuries can be life-threatening, it's crucial to promptly assess and treat them. Pneumothorax and hemothorax are among the most common injuries associated with chest trauma.

Causes

Chest trauma is classified based on the mechanism of injury, namely blunt force trauma and penetrating trauma due to sharp objects. Injuries caused by blunt trauma to the chest are more commonly encountered than penetrating trauma. Individuals who experience blunt trauma in motor vehicle accidents are at risk of experiencing high levels of pain and a high risk of death if the collision occurs at high speeds and seat belts are not used.

Blunt trauma

Blunt force trauma refers to impacts on the chest that cause increased pressure within the chest cavity. Conditions grouped into blunt trauma include motor vehicle collisions (the most common cause of chest trauma), falls from heights, violence, and accidents due to explosions. Only 10% of all cases of blunt trauma to the chest require surgical procedures.

Sharp trauma

Penetrating trauma due to sharp objects refers to trauma that occurs due to gunshot wounds, stab wounds, and other wounds that penetrate the chest cavity. Although the number of cases of blunt trauma to the chest tends to be high, sharp trauma to the chest results in a higher death rate compared to blunt trauma. Furthermore, sharp trauma to the chest also results in approximately 15-30% of individuals requiring surgical intervention. This figure is higher compared to cases of blunt trauma to the chest.

Risk factor

Motor vehicle accidents are the leading cause of chest trauma, responsible for 80 percent of cases. The risk of death in cases of chest trauma is significantly higher for patients over 65 years of age, those with three or more fractured ribs, as well as those with heart and lung diseases.

Symptoms

Several symptoms may occur with chest trauma, including:

• Difficulty breathing
• Difficulty or failure of the chest to expand normally
• Tenderness on the ribs
• Bruising
• Coughing up blood
• A portion of the chest wall may not move during breathing or may move opposite to other parts of the chest wall (flail chest).

Diagnosis

Doctors will conduct a rapid initial examination of individuals who arrive at healthcare facilities with chest trauma. The initial examination includes:

• Checking for airway obstruction in the patient's air passages
• Assessing whether the patient is breathing well and if both sides of the patient's chest expand symmetrically
• Examining the patient's pulse rate and skin condition
• Assessing the patient's level of consciousness and other signs and symptoms visible on the patient's body

The healthcare provider will also ask about the individual accompanying the patient to the medical facility. Furthermore, the healthcare provider will investigate further into the patient's medical background. To determine a diagnosis, your healthcare provider may conduct various diagnostic tests.

Chest X-ray

Chest X-ray examination is one of the types of diagnostic tests commonly performed for chest trauma because it is quick, easily obtained, and readily accessible.

Ultrasound (USG)

Evaluation using ultrasound in cases of trauma or FAST ultrasound (Focused Assessment with Sonography in Trauma) focuses on examining and assessing the chest and abdominal cavities. FAST ultrasound can be performed in the early stages of trauma assessment in unstable patients. Ultrasound is one of the options for detecting fluid and air accumulation in the chest and abdominal cavities after chest trauma.

CT scan of the chest or MRI

The use of imaging tests with CT scans or MRI to evaluate chest trauma is considered to provide more sensitive results compared to chest X-ray examinations.

Esophagoscopy and bronchoscopy

Injuries to the esophagus or trachea are often difficult to diagnose due to the lack of specific symptoms associated with esophageal injuries. Esophageal injuries are very rare in blunt force trauma and are more common in severe trauma that affects multiple areas at once. The symptoms that arise tend to be nonspecific, making them difficult to diagnose. This examination is performed by inserting a camera-equipped tube into the esophagus or bronchus in the lower respiratory tract.

Management

The management of patients with chest trauma depends on the severity of symptoms and the patient's condition upon arrival at the healthcare facility. If the symptoms are mild, the patient is usually closely monitored and given pain relievers. It's important not to ignore pain, as it can worsen and slow down the healing process. In addition to pain relievers, doctors may also prescribe antibiotics if there are open wounds with a risk of contamination in the patient, or as a preventive measure against infection before surgery.

Therapy also depends on the specific injuries resulting from the trauma, such as broken bones, bleeding, compression or pressure on organs around the chest area, air leaks, or severe respiratory disturbances. Treatment may involve administering intravenous fluids or blood transfusions, especially in cases of bleeding, placing a small tube in the chest area to reduce pressure on the lungs or drain blood accumulating in the chest cavity, and providing oxygen.

If life-threatening injuries are detected, doctors will immediately initiate treatment. While the majority of chest trauma can be managed without requiring surgery, surgical procedures should be performed promptly where such intervention is necessary.

Complications

Within the chest cavity are respiratory passages, lungs, heart, and large blood vessels that play vital roles in the body. The more major structures are injured, the more significant the complications can occur. Some complications that may arise from chest trauma include damage to surrounding nerves, infections, lack of blood supply to body organs resulting in shock, and even death.

Prevention

Motor vehicle accidents are one of the most common causes of chest trauma. Therefore, one way to prevent chest trauma is to be cautious while driving by wearing helmets or seat belts and not exceeding safe speed limits.

When to see a doctor?

If you encounter someone who has suffered a chest injury, immediately take them to a doctor or the nearest emergency room for prompt treatment.